2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults |
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| Affiliation: | 1. Division of Cardiology, Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;2. Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada;3. Max Rady College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada;4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada;5. Division of Endocrinology, Unity Health Toronto and Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada;6. Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada;7. Keenan Research Center for Biomedical Science, St Michael’s Hospital, Toronto, Ontario, Canada, and Division of Cardiology, University of Toronto, Toronto, Ontario, Canada;8. Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada;9. LMC Diabetes and Endocrinology, Vaughan, Ontario, Canada;10. Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada;11. Division of Nephrology, Department of Medicine, Humber River Hospital, North York, Ontario, Canada;12. Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada;13. Alberta Diabetes Institute, Edmonton, Alberta, Canada;14. Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada;15. Division of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada;p. Department of Cardiology, Selkirk Regional Health Centre, Selkirk, Manitoba, Canada;q. Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;r. Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada;s. Division of Endocrinology and Metabolism, McGill University, Montreal, Quebec, Canada;t. Division of Cardiology (Regina), Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;u. Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada;1. Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, Ontario, Canada;2. Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;3. Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;1. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada;2. Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada;3. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;4. Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;5. Cardiac Sciences Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada;6. Dalhousie University, Halifax, Nova Scotia;7. University of Saskatchewan, Regina, Saskatchewan, Canada;8. Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada;9. Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada;10. McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | This guideline synthesizes clinical trial data supporting the role of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors (SGLT2i) for treatment of heart failure (HF), chronic kidney disease, and for optimizing prevention of cardiorenal morbidity and mortality in patients with type 2 diabetes. It is on the basis of a companion systematic review and meta-analysis guided by a focused set of population, intervention, control, and outcomes (PICO) questions that address priority cardiorenal end points. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system and a modified Delphi process were used. We encourage comprehensive assessment of cardiovascular (CV) patients with routine measurement of estimated glomerular filtration rate, urinary albumin-creatinine ratio, glycosylated hemoglobin (A1c), and documentation of left ventricular ejection fraction (LVEF) when evaluating symptoms of HF. For patients with HF, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy for the reduction of hospitalization for HF when LVEF is > 40% and for the reduction of all-cause and CV mortality, hospitalization for HF, and renal protection when LVEF is ≤ 40%. In patients with albuminuric chronic kidney disease, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy to reduce all-cause and CV mortality, nonfatal myocardial infarction, and hospitalization for HF. We provide recommendations and algorithms for the selection of glucagon-like peptide-1 receptor agonists and SGLT2i for patients with type 2 diabetes and either established atherosclerotic CV disease or risk factors for atherosclerotic CV disease to reduce all-cause and CV mortality, nonfatal stroke, and for the prevention of hospitalization for HF and decline in renal function. We offer practical advice for safe use of these diabetes-associated agents with profound cardiorenal benefits. |
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